What is the best management approach for a 35-year-old male patient presenting with bilateral callus (hyperkeratosis) formation on the soles of both feet?

Management of Bilateral Callus Formation on the Soles of Feet

Professional debridement by a podiatrist using a scalpel or blade is the recommended first-line treatment for callus management, followed by pressure redistribution through appropriate footwear and cushioning to prevent recurrence. 1, 2

Assessment and Diagnosis

• Evaluate the calluses for:

  • Location (typically under metatarsal heads or pressure points)
  • Appearance (hard, thickened areas of skin)
  • Pain level (especially during weight-bearing)
  • Signs of inflammation (redness, warmth)
  • Presence of cracks or fissures
  • Any underlying blisters 1

• Check for contributing factors:

  • Ill-fitting footwear
  • Abnormal foot mechanics or deformities
  • High activity levels
  • Weight distribution issues 2, 3

Treatment Algorithm

Step 1: Professional Debridement

• Refer to a podiatrist for manual debridement using a scalpel or blade
• This provides immediate relief by removing thickened tissue
• Caution against overdebridement which can increase tenderness 1, 2

Step 2: Post-Debridement Care

• Apply emollients and non-adherent dressings to protect the debrided skin
• Urea-based creams can help keep the skin soft and prevent recurrence 1, 2

Step 3: Address Mechanical Causes

• Prescribe properly fitting footwear with:

  • Adequate width (especially at metatarsal phalangeal joints)
  • Rounded toe box
  • Proper length (1-2 cm longer than foot) 2

• Consider pressure redistribution options:

  • Cushioning insoles
  • Metatarsal pads
  • Custom orthotics if needed 2

Step 4: Patient Education for Self-Care

• Teach gentle self-debridement using pumice stone or emery board
• Instruct on daily application of moisturizers or keratolytic agents
• Advise against barefoot walking
• Demonstrate proper toenail care (cut straight across) 1, 2

Follow-Up Care

• Schedule follow-up in 1-3 weeks to assess treatment response
• Regular maintenance debridement may be necessary (every 4-8 weeks)
• Monitor for any signs of complications:
  • Fissures
  • Infection
  • Ulceration (especially if patient has diabetes) 2

Special Considerations

• If calluses are particularly painful or thick, more frequent professional debridement may be required

• For persistent calluses despite treatment, consider:

  • Gait analysis to identify abnormal pressure distribution
  • Custom-made therapeutic footwear
  • Specialized orthoses designed to redistribute weight and pressure 2, 4

• Surgical intervention is rarely indicated and should only be considered if:

  • Conservative measures have failed
  • There is an underlying structural abnormality causing persistent callus formation 3, 5

Prevention of Recurrence

• Regular use of appropriate footwear
• Continued use of prescribed orthotics or insoles
• Maintenance of proper foot hygiene and moisturizing
• Periodic professional assessment and debridement as needed 2

By following this management approach, most patients with bilateral callus formation will experience significant improvement in symptoms and prevention of recurrence.